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Diabetes in Humans
type 1, 2 and 3


Leo Rogier Verberne


6. Treatment of diabetes type 1, 2 and 3

Physical exercise
During physical labour the muscles burn glucose and the level of blood glucose drops. The mechanism behind it is that bodily exercise renders the glucose gates more sensitive to insulin, as a result of which more glucose is absorbed by the organs and muscles. Provided that any insulin is present in the blood. Which is not the case in untreated juvenile diabetics, so that the glucose gates remain closed in those type 1 diabetics even during physical exercise. But, on the other hand, prediabetics can keep their blood glucose concentration at a normal level for many years by daily exercise, even without medication. Provided that they avoid an excess of sugar intake.

Sugar-free diet
People with diabetes have been observing a low-carb and sugar-free diet since 1797 (12). It became the standard treatment for diabetes in the 19th century. It limits the rise of the blood glucose level indeed, and with that, the excessive thirst and frequent urination. But when insulin is insufficient or lacking, it is impossible for the muscles and organs to take in enough glucose. So the fatigue and hunger do not disappear. Insulin has been extracted from animal slaughter remnants and injected into diabetics since 1922. This was a life-saving measure for juvenile diabetics. The sugar-free diet was no longer necessary and was gradually abandoned. The present dietary recommendations for diabetics dictate regularity in meals using a variety of foods of which approx. half consists of carbohydrates.

Herbs
For centuries (parts of) plants have been used because of their healing qualities. The flowers of the camomile, for example, were designated to be curative in Norwegian mythology for various ailments (Balder’s brow). Administering camomile-extract to diabetic rats is found to lower the blood sugar level (4). But this effect has not been demonstrated in humans with diabetes. During physical labour the muscles burn glucose and the level of blood glucose drops. The mechanism behind it is that bodily exercise renders the glucose gates more sensitive to insulin, as a result of which more glucose is absorbed by the organs and muscles. And thus prediabetics can keep their blood glucose concentration at a normal level by daily exercise, even without medication; provided that they consume healthy nutrition and avoid an excess of sugar intake. There have been reports of cinnamon having a blood sugar reducing effect in people (1). The doses used, however, were extremely high and the effect could not be confirmed in later studies. In addition, a favourable effect on diabetes is attributed to fenugreek, Gymnema silvestre (trumpet), Curcuma longa (turmeric) and Haarlemmerolie (a mixture of sulphur, herbs and terebinth oil). But these data are based on tradition and experience (empiricism). The results have not been compared to an untreated control group, which renders the data of no use scientifically.

Alcohol
The consumption of alcohol causes the blood sugar level to drop, provided that the alcoholic beverage itself does not contain sugar. Alcohol is produced through the fermentation of dextrose. A mere 100 ml of old, thoroughly fermented (dry) red wine still contains 1 to 3 grams of glucose. This may be as high as 28 grams per 100 ml in sweet wines (6). As a result, the blood sugar level initially increases somewhat after consuming wine, only to decrease after that. Beer also contains sugar and, as a result, causes this yoyo-effect. Liquor (gin, whiskey) does not contain sugar. And so such a drink will immediately lower the blood sugar level. This explains how appetizers work: they drop the glucose level, also in the brain, what stimulates the hunger centre. Compared to a control group of total abstainers, significantly less adult-onset diabetes was found after a few years in a group of people who consumed a moderate amount of alcohol on a daily basis (two glasses of wine with dinner) (3).

Juvenile diabetes
Regulation of the blood glucose concentration in juvenile diabetics requires daily injections of insulin. As of 1922, insulin was isolated from the pancreas of animals after slaughtering, particularly pigs. It wasn’t until 1982 that synthetic human insulin became available. It contains no animal protein, and so over-sensitivity will not develop even after repeated use. Insulin analogs with varying periods of effectiveness have been available since 1996 (10). Various periods of effectiveness make it possible to achieve a stable blood glucose level for a 24-hour period. To that end, a long acting insulin preparation for the basic level is combined with a short-lived preparation in order to set off the glucose peak after meals.

Table 1. Various types of synthetic human insulin (10)

Category

Effective

within

Optimal

effect

Goal

rapid acting 0-15 min. 1- 3 hours (meal) peak
short acting 30 min. 1- 4 hours (meal) peak
medium-long acting 90 min. 4-12 hours basic level
long acting 30-60 min. 12-24 hours basic level


Which preparation you are to use depends upon the type of carbohydrates that you eat or drink; the dose depends upon the amount of carbohydrates consumed (11). Easily digestible sugars in fruit juices or energy drinks require the use of rapidly acting insulin preparations. Carbohydrates that are slower to digest, such as those in bread, require a preparation that releases insulin more slowly. Starch that digests slowly, like potato starch, requires long acting insulin just like the preparation that is used for the basic level.

Adult-onset diabetes
In the case of manifest adult-onset diabetes, the use of certain oral drugs is required (table 2), even when a healthy diet and regularly physical exercise are already part of the lifestyle.

Table 2. Blood glucose reducing oral drugs (5)

Active agent

Daily dosage

Drug

Effect

metformine 500-3000 mg Metformine increases insulin sensitivity
pioglitazon 15-45 mg Actos increases insulin sensitivity
rosiglitazon 4-8 mg Avandia increases insulin sensitivity

glibenclamide 2,5-15 mg Glibenclamide stimulates β-cells
glicazide 80-240 mg Diamicron stimulates β-cells
glimepiride 1-6 mg Amaril stimulates β-cells
tolbutamide 500-2000 mg Tolbutamide stimulates β-cells

saxagliptine 5 mg Onglyza strengthens incretine-effect
sitagliptine 25-100 mg Januvia strengthens incretine-effect
vildagliptine 50 mg Galvus strengthens incretine-effect

Some of these drugs (upper group) increase the sensitivity of the glucose gates to insulin, allowing more glucose to enter the organs at the same insulin level. As a result the blood glucose concentration drops. Sulphonylureum derivatives (middle group) stimulate the β-cells to step up the insulin production. A third group of drugs inhibits the degradation of the intestinal hormones that stimulate the β-cells to produce insulin (lower group); this increases the incretin-effect, lowering the blood sugar level that way. The treatment of manifest diabetes type 2 often involves a combination of medicines from the different groups mentioned in the table (5,7). More recently developed substances that can lower the blood glucose level in adult-onset diabetes are exenatide and liraglutide. They are called incretin-mimetics because they are synthetic analogs of the intestinal hormones that cause the incretin-effect. And so they too stimulate the β-cells in the pancreas to step up the insulin production. However, these more recently developed preparations have severe side-effects and moreover, they are expensive. And so they are only used on specific medical grounds (9).

MODY
In most cases, people with MODY are more sensitive to insulin and blood glucose reducing tablets than people with diabetes type 1 or 2. Thus type 3 diabetics usually need less medication (2). For example, MODY3 patients usually need lower insulin dosages than type 1 diabetics because there is some natural insulin production left. MODY2 needs no medication at all, most of the time, because balanced nutrition and regular exercise are sufficient for regulation. If not, people with MODY(2) react better on a treatment with sulphonylureum derivatives (table 2 middle row) than adult-onset diabetics so that dosing can be lower in MODY diabetics (2).

Conclusions
1. Physical exercise lowers the blood glucose concentration because it increases the sensitivity of the glucose gates in the organ membranes for insulin.
2. A sugar-free and low-carbohydrate diet will reduce the blood glucose level in diabetics, but the intake of glucose in the organs will remain insufficient or even impossible (in type 1 diabetics) due to a lack of insulin.
3. A variety of herbs has been used as therapy for diabetes, but these have not been sufficiently researched and their effect is doubtful.
4. Alcohol consumption lowers the blood sugar concentration, but many alcoholic drinks also contain sugar.
5. Various synthetic insulins with different speeds of insulin release are available for the regulation of the blood glucose level in juvenile diabetes and MODY(3).
6. Blood glucose reducing oral drugs are effective in adult-onset diabetes and various types of MODY because they:
- increase insulin sensitivity of the glucose gates in the organ membranes or
- incite the β-cells in the pancreas to step up the production of insulin or
- boost the incretin-effect.
7. MODY diabetics usually need less medication than juvenile or adult-onset diabetics.

References
1. Diabetes Fonds (2011). Verlaagt kaneel de bloedsuiker?
2. Erfocentrum (2017). MODY
3. Joosten M (2011). Thesis Wageningen University. Moderate alcohol consumption, adiponectin, inflammation and type 2 diabetes risk.
4. Kato A, Minoshima Y, Yamamoto J, Adachi I, Watson AA and Nash RJ (2008). J Agric Food Chem; 56(17): 8206-11; Protective effects of dietary chamomile tea on diabetic complications.  
5. Kooy A (2010). Diabetes Mellitus; nieuwe inzichten en behandelingsopties anno 2010; ISBN 978-90-313-7434-2
6. Robin990 (2015). Diabetes en rode wijn: een gezonde combinatie
7. Sitsen JMA, Vasbinder E. Geneeskundig jaarboek 2011; 128e jaargang; ISBN 978-90-313-8614-7
8. Steunpunt Koel (2017). Eerstelijnsprotocollen; SU-derivaten
9. Tack CJ en Stehouwer CDA. Diabetes mellitus. In: Interne geneeskunde. eds. Stehouwer, Koopmans en van der Meer. 14e druk (2010); ISBN 978-90-313-7360-4; p 842-843
10. Wikipedia.nl (2016). Insuline
11. Wikipedia.nl (2016). Insulinetherapie
12. Wikipedia.en (2016). Low-carbohydrate diet

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© Leo Rogier Verberne
ISBN/EAN:978-90-825495-4-6
www.diabetesbook.org


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